HCS#2 HB 357 & 298 -- INSURANCE COVERAGE FOR AUTISM SPECTRUM
DISORDERS

SPONSOR:  Cooper (Scharnhorst)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Health
Care Policy by a vote of 10 to 0.

Beginning January 1, 2010, this substitute requires health
carriers issuing or renewing a health plan to provide individuals
younger than 18 years of age insurance coverage for the diagnosis
and treatment of autism spectrum disorders (ASD).  Carriers
cannot deny or refuse to issue insurance coverage on; refuse to
contract with; or refuse to renew or reissue, terminate, or
restrict coverage on an individual or his or her dependent solely
because of being diagnosed with ASD.  The coverage provided by an
insurance carrier for ASD is limited to the treatment ordered by
the insured individual's licensed treating physician or
psychologist in accordance with a treatment plan.  Except for
inpatient services, the health benefit plan or carrier can
request a review of the treatment not more than once every six
months at its expense unless the individual's treating physician
or psychologist agrees that a more frequent review is necessary.

Individual coverage for the applied behavior analysis will have a
maximum benefit of $55,000 per year for individuals younger than
15 years of age, and there is no maximum benefit limit for
individuals 15 years of age and older with no limit on the number
of times an individual visits an autism service provider.  After
December 31, 2010, and annually thereafter, the Director of the
Department of Insurance, Financial Institutions and Professional
Registration must adjust the maximum benefit for applied
behavioral analysis for inflation using the Medical Care
Component of the United States Department of Labor Consumer Price
Index for All Urban Consumers.

Payments made by a health carrier for health services unrelated
to ASD for an individual with ASD cannot be applied toward the
ASD maximum benefit.  ASD services cannot be subject to any
greater deductible, co-insurance, or co-payment than other
physical health care services provided by the health benefit
plan.  Payments and reimbursements for applied behavior analysis
services provided by a person performing diagnostic or treatment
services for ASD, known as a direct implementer, must be made to
a person who supervises the direct implementer who is certified
by the Behavior Analyst Certification Board within the National
Commission for Certifying Agencies or an entity or group for whom
the supervising person works or is associated.

Health care plans delivered, issued, continued, or renewed on or
after January 1, 2010, to employees and their dependents under
the Missouri Consolidated Health Care Plan, self-insured
governmental plans, self-insured group arrangements, plans
provided through a multiple employer welfare arrangement if
permitted by the federal Employee Retirement Income Security Act
of 1974, and self-insured school district health plans are
subject to ASD coverage requirements.

Individually sold health benefit plans and certain other
supplemental insurance policies are not subject to ASD coverage
requirements.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
could exceed $3,003,275 in FY 2010, Unknown could exceed
$6,006,550 in FY 2011, and Unknown could exceed $6,006,550 in FY
2012.  Estimated Cost on Other State Funds of Could exceed
$632,300 in FY 2010, Could exceed $1,275,800 in FY 2011, and
Could exceed $1,275,800 in FY 2012.

PROPONENTS:  Supporters say that the bills contain
recommendations from the Blue Ribbon Panel on Autism and that not
all children will require the maximum benefit of $72,000 per year
in applied behavior analysis therapy.  Autism is a
neurobiological disorder that responds well to treatment, and the
number of cases is growing.  The insurance mandate in the bills
will only result in a nominal increase in cost, estimated at 1%
per member per month.  In the long term, the cost of mandating
coverage will be less than not treating a child with autism.

Testifying for the bills were Representatives Scharnhorst and
Grisamore; Rebecca Blackwell, Judevine Center for Autism; John F.
Montovani, MD; Lorri Unumb, Autism Speaks; Ron Ashworth; Jennifer
Gray; Molly Schad; Jenny Whitty; Kelli Maxwell; and Louise
Diender.

OPPONENTS:  Those who oppose the bills say that health insurance
costs will increase, and the increased costs, estimated between
2.5% and 3% per member per month, will result in more groups
dropping coverage.  Coverage will only be extended to 22% of
people with autism.  A mandated offer for coverage rather than an
insurance mandate would be a better option.  Applied behavior
analysis is considered an educational intervention and,
therefore, not covered by insurance policies.

Testifying against the bills were America's Health Insurance
Plans; Missouri Insurance Coalition; Anthem Blue Cross and Blue
Shield; Coventry Health Care; and United Health Care.

OTHERS:  Others testifying on the bills say some students with
early interventions like applied behavior analysis therapy might
not require any special education.  Public schools serve all
children, but they do not treat medical disorders and don't have
time to provide the therapy required by applied behavior
analysis.

Testifying on the bills was Gay Tompkins.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:24 am